Client Agreement
By completing this form, you acknowledge that:
I understand that holistic nutrition is not covered by the provincial government (OHIP), though
may be covered by private and extended insurance plans. Holistic nutrition may also be tax
deductible.
I understand that working with a holistic nutritionist is a joint responsibility between me (the
client), and the practitioner. Improving my lifestyle can be as important as the remedies and
recommendations.
Informed Consent
I understand that holistic nutrition can be employed in conjunction with other forms of therapy
and need not be considered exclusively beneficial. I acknowledge that working with other
health care professionals will provide a more comprehensive and balanced wellness program.
I understand that the services provided are at all times restricted to consultation on the subject
of health matters intended for general well-being and are not meant for the purpose of medical
diagnosis, treatment, or prescribing of medicine for any disease, or any licensed or controlled
act which may constitute the practice of medicine. Holistic nutrition does not substitute or
replace routine medical visits, tests, or other medicines prescribed by other health care
practitioners.
I recognize that even the gentlest forms of treatment potentially have their risks and
complications. The risks associated with holistic nutrition include, but are not limited to,
aggravation of pre-existing symptoms, allergic reactions to supplements or herbs, and
interactions with prescription medications.
I voluntarily consent to work with an RHN and I intent for this consent form to cover my entire
course of treatment with the RHN. I understand that I am free to withdraw my consent at any
time.
